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DR. DOROTHY T PRUSEK M.D.
NPI 1871592378
Internal Medicine in Elmhurst, IL

Active since July 18, 2005PECOS EnrolledAccepts Medicare Assignment
91.35/100
CMS Quality Rating
755 N YORK ST, ELMHURST, IL 60126(331) 221-2900(331) 221-2733 Get Directions Write a Review

NPPES record last updated: February 8, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 8, 2021, Feb 1, 2021, Mar 17, 2016 and 1 more (4 updates tracked since 2016).

About Dr. Dorothy T Prusek M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DOROTHY T PRUSEK M.D. (NPI 1871592378) is an individual internal medicine provider in Elmhurst, Illinois, licensed in Illinois (036081546) and active in the NPI registry since July 2005. She is enrolled in Medicare PECOS, is affiliated with Elmhurst Memorial Hospital, and is a graduate of Other (1987).

NPPES Registry Identity

NPI1871592378
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. DOROTHY T PRUSEKCredential: M.D.
Location Address755 N YORK STElmhurst, IL 60126-1607
Mailing Address755 N York StElmhurst, IL 60126-1607 · (331) 221-2900 · Fax (331) 221-2733
Phone(331) 221-2900
Fax(331) 221-2733
Sole ProprietorNo
Medical School CMSOtherGraduated 1987
Enumeration DateJuly 18, 2005
Last NPPES UpdateFebruary 8, 20214 updates tracked since enumeration
NPPES CertifiedFebruary 8, 2021
✔ NPI 1871592378 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in IL · 036081546
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
755 N YORK ST, Elmhurst, IL 60126
Open in Google Maps ↗

Other Identifiers 2

Other02232472IL · Blue Cross/blue Shield #
Medicaid036081546IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Dorothy T Prusek M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345221115
PECOS Enrollment IDI20040527000247
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Dorothy Prusek reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Edward Health Ventures
4.0 mi
Clinic/Center
1200 S YORK ST, STE 3160
Elmhurst, IL 60126
  • Reassigned Medicare billing, Illinois enrollment
  • 561 clinicians in this Medicare group
NPI 1275963027 (331) 221-9090
Endeavor Health Medical Group
16 mi
Allergy & Immunology
1000 CENTRAL ST
Evanston, IL 60201
  • Reassigned Medicare billing, Illinois enrollment
  • 4,841 clinicians in this Medicare group
NPI 1497701882 (847) 570-5235

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
290 services159 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
245 services245 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
56 services50 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
25 services24 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
25 services24 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
24 services20 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Elmhurst Memorial Hospital

Acute Care Hospitals · Elmhurst, IL
4/5 CMS rating
OwnershipProprietary
CMS Certification Number140200
Location155 East Brush Hill RoadElmhurst, IL 60126 · Du Page County
Emergency services Birthing friendly

Edward Hospital

Acute Care Hospitals · Naperville, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140231
Location801 South WashingtonNaperville, IL 60540 · Du Page County
Emergency services Birthing friendly

Alexian Brothers Medical Center 1

Acute Care Hospitals · Elk Grove Village, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140258
Location800 Biesterfield RdElk Grove Village, IL 60007 · Cook County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60126 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.35/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality82.71
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 9

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
20 suppliers64 claims156 services$5.25 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
8 suppliers15 claims15 services$0.95 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
5 suppliers16 claims16 services$33.81 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
5 suppliers12 claims12 services$44.14 avg. paid by Medicare
Headgear used with positive airway pressure device A7035
DME-Other DME · category DE001N
4 suppliers13 claims13 services$14.53 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
5 suppliers20 claims120 services$1.76 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FRANKLIN CHANG
Family Medicine
755 N YORK ST
ELMHURST, IL 60126
Dupage County (331) 221-2900
MAIS TRABOLSI MD
Internal Medicine
755 N YORK ST
ELMHURST, IL 60126
Dupage County (331) 221-2900
KRISTINE LYNETTE MONTERO NICHOLS APN-CNP
Nurse Practitioner
755 N YORK ST
ELMHURST, IL 60126
Dupage County (630) 527-3645
JACQUELINE ROSS M.D.
Family Medicine
755 N YORK ST
ELMHURST, IL 60126
Dupage County (331) 221-2900
AMY ELIZABETH STROM MD
Family Medicine
755 N YORK ST
ELMHURST, IL 60126
Dupage County (331) 221-2900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dorothy Prusek's NPI number?

The NPI number for Dorothy Prusek is 1871592378. It was assigned to this individual provider in the NPPES registry on July 18, 2005.

Where is Dorothy Prusek located?

Dorothy Prusek practices at 755 N York St, Elmhurst, IL 60126. The listed phone number is (331) 221-2900.

What is Dorothy Prusek's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Dorothy Prusek enrolled in Medicare?

Yes. Dorothy Prusek is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Dorothy Prusek's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dorothy Prusek reassigns Medicare benefits to 2 organizations: Edward Health Ventures (Elmhurst, IL) and Endeavor Health Medical Group (Evanston, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dorothy Prusek's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Dorothy Prusek accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Dorothy Prusek as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Dorothy Prusek affiliated with any hospitals?

According to CMS data, Dorothy Prusek is affiliated with Elmhurst Memorial Hospital, Edward Hospital and Alexian Brothers Medical Center 1.

When was this NPI record last updated?

The NPPES record for Dorothy Prusek was last updated on February 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.